Controlled Substance Prescription Laws: Exceptions

D-I-Y?

Physicians may write prescriptions for themselves, but they are not allowed to write their own controlled substance prescriptions.

Pharmacists are not allowed to dispense their own controlled substance prescriptions to themselves.

Out of State prescriptions

If a patient form California presents a prescription written by an out of state prescriber you may fill it if it is a Schedule III-V but not if it is for a Schedule II drug. If it is suspicious you should verify the validity of the prescription and also make sure the out of state prescriber has the authority to write this prescription under their state laws.

Schedule III-V prescriptions written by an out of state prescriber may be filled in California and delivered out of state, if they comply with the law of the state where they were issued.

Who may transmit a prescription order?

A prescriber or an authorized agent may transmit an oral, electronic or written prescription. Pharmacists must make sure the “agent” actually does have the authority to transmit the prescription. Although the agent cannot diagnose the patient or determine the need for a controlled substance prescription, they can prepare most of the prescription and transmit it to the pharmacy.

Schedule III-V prescriptions may be transmitted orally or electronically by an authorized agent, if the written record of the prescription specifies the name of the agent. (The pharmacy must record the name of the person transmitting the order.)

Schedule II prescriptions may not be transmitted by an agent. Schedule II prescriptions may be faxed by the prescriber as long as the original written prescription is received prior to dispensing.

Who is considered an authorized agent?

In a health care facility, provided the prescriber authorizes the order, the following are considered authorized agents:

pharmacist
registered nurse
licensed vocational nurse
licensed psychiatric technician
other authorized healing arts licentiate employed by the facility

Filling prescriptions for patients at different institutions

Hospital chart orders: An order for controlled substances for use by a patient in a licensed hospital does not have to be written on a controlled substance form, but it must be in writing on the patient's record, signed by the prescriber, dated, and state the name and quantity ordered and administered. This record needs to be kept by the hospital for at least 7 years. This does not apply for discharge medications.
Skilled Nursing Facility, Intermediate Care Facility or Hospice Patients: Schedule II controlled substances may be dispensed upon electronic order, which must be printed and signed by the pharmacist. This must contain the date of transmission, patient name, name and address of the facility, name and quantity of controlled substance, directions for use, and prescriber information.
Terminally ill patients: A terminally ill patient is defined as someone who is suffering from an incurable, irreversible illness, is expected to die within one year and is being treated mainly for control of pain or symptom management. An ordinary written and signed prescription can be written for a terminally ill patient and be valid for a CII as long as the words "11159.2 exemption" are written on the prescription exactly.
Clinic patients:
- Clinics may not dispense Schedule II controlled substances, although individual physicians at the clinic may dispense Schedule IIs to their own patients as otherwise permitted by law. Schedule IIs may be administered on the premises of a surgical clinic.
- When an order for a controlled substance other than a Schedule II is issued for a non-profit clinic patient, other than for outpatient use, the order is exempt from the usual requirements for a controlled substance prescription. A written entry on the patients chart signed by the prescriber is sufficient if it includes the name and quantity of the controlled substance, the amount furnished and the date. That record must be kept for 7 years. The clinic must maintain a separate record of the controlled substances it furnishes. Clinics as well as pharmacies are required to report Schedule II, III and IV prescription information weekly to the CURES system.

Emergencies

Schedule II prescriptions may be dispensed following an oral, electronic, or written order in an emergency. An emergency is defined as a situation in which the failure to issue a prescription may result in the loss of life or intense suffering. Before filling the order, the pharmacist must reduce an oral or electronic data transmission order to hard copy form and if a written order is used it must be signed and dated by the prescriber in ink. A proper controlled substance prescription must be mailed or provided to the pharmacy within 7 days from when the drug was dispensed. If the prescription is not received in time, the pharmacy must notify the BNE within 144 hours and a record must be kept.

Under California law any drug including controlled substances, may be dispensed without a prescription during a declared federal, state or local emergency. The pharmacist must keep a record of the date, name and address of the patient, and the name, strength, and quantity of the drug furnished. This information must be communicated to the patient’s physician as soon as possible. The Governor could modify controlled substance as well as pharmacy laws and regulations, as deemed necessary and safe. Federal laws remain in effect and federal controlled substance regulations make no provision for an emergency, but federal authorities would be unlikely to take disciplinary action.

Improper Filling

Once the prescription reaches the pharmacy, it is not enough that the prescriber is legally authorized to prescribe and the prescription is in the right form with all the required information. It is the pharmacist’s responsibility to exercise their best judgment to determine the actual legitimacy of the prescription. A person who knowingly violates this standard loses the protection given by his or her license.

Knowingly selling, furnishing giving away or administering any controlled substance to an addict or habitual user, unless otherwise authorized by law is unprofessional conduct. However it is legal for a physician to prescribe, dispense, or administer controlled substances to an addict under his or her care for treatment of conditions other than addiction itself and a pharmacist may of course fill this prescription.

Picture Sources:
http://thehonesttoddler.com/guest-post-real-actual-doctor/prescription-pad-used-for-addictive-drugs/
http://www.bs757.com/2012/03/cdc-too-many-women-skip-health-screening/patient-chart-2/
http://www.udel.edu/studenthealth/services-for-students/medical_clinic.html
http://www.crwflags.com/fotw/flags/int-red.html

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Exceptions